JOB DESCRIPTION

Job Summary
Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering on NCQA accreditation requirements. Plans and directs schedules, reporting, process improvement, and implores continuous quality improvement. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions’ primary focus is project/program management.
Job Duties
Program Oversight & Project Management
Directs accreditation work plans and timelines to meet NCQA and contractual deadlines.
Manages cross-functional teams and external vendors to ensure deliverables align with NCQA standards.
Oversees submissions to NCQA and regulatory bodies, ensuring accuracy and timeliness.
Compliance & Quality Improvement
Monitors key performance indicators (KPIs) and facilitates root cause analyses.
Leads internal audits and file review rehearsals.
Ensures survey readiness by maintaining documentation and evidence of compliance.
Consultation & Collaboration
Serves as a strategic advisor to market teams, mentoring them through the accreditation process.
Facilitates workgroups and committee meetings to address market-specific barriers and drive improvement.
Coordinates with Delegation Oversight to ensure vendor and delegate compliance.
Reporting & Documentation
Writes narrative reports interpreting regulatory specifications and documenting program outcomes.
Maintains and updates policies, procedures, and accreditation-related resources.

REQUIRED EDUCATION :

Bachelor’s degree or equivalent experience in healthcare or public health.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

3-5 years of Program and/or Project management experience.
Operational Process Improvement experience.
Healthcare experience.
Experience with Microsoft Project and Visio.
Excellent presentation and communication skills.
Experience partnering with different levels of leadership across the organization.

PREFERRED EDUCATION :

Master’s in Public Health, Nursing, or Clinical Quality.

PREFERRED EXPERIENCE :

Minimum 5 years in healthcare, with 2+ years in health plan quality improvement or managed care. (HIGHLY PREFERRED)
Strong knowledge of NCQA standards and EQRO functions. (HIGHLY PREFERRED)
Proficiency in Excel, Visio, and project management tools.
Demonstrated business writing and analytical skills.
Certified Professional in Healthcare Quality (CPHQ).
Experience with Medicare and Medicaid programs.
Familiarity with NCQA file review standards and surveyor interactions.
Experience with conducting Utilization Management and Population Health Management file audits, reporting results, and working collaboratively to create remediation plans.
Skills & Competencies
Strategic thinking and problem-solving.
Strong oral and written communication.
Ability to lead cross-functional teams and manage multiple priorities.
Detail-oriented with a focus on compliance and continuous improvement.
Able to work in a highly matrixed environment, independently and in cross functional teams, and ability to be a self-motivator.

Please refer the Job description for details